Sam started off by networking with lots of enthusiasm. He showed his face everywhere. He joined the Chamber of Commerce. He attended every school function he could. He met with pediatricians. He gave free seminars to the staff of private schools. But the referrals were slow in coming. I told him he needed a website, but he wasn't interested because he thought no "good clients" would look for a therapist online. I showed him research indicating that 70 percent of people now search for professional services online first, and told him that I'm getting 30 referrals a month from my website, and he suddenly got interested. Because he was fairly computer savvy, he decided to create his own website, finding an inexpensive web-based service called Site Build It (http://buildit.site sell.com). He built the entire site in six weeks and learned the basics of search-engine optimization to help potential clients find him more consistently. Despite this, his site initially showed up on page 16 of Google search results and wasn't generating referrals. Impatient and frustrated, he asked me, "Why did I waste all that time creating a website, just to have it sit there?" Meanwhile, the bills at home were piling up and his savings were dwindling.

So we discussed pay-per-click advertising with Google AdWords. Pay-per-click ads are the small, three- or four-line text ads that usually show up on the right column of Google search results. It is the most highly targeted form of marketing available today, because instead of trying to find clients through advertising in the traditional way, potential clients find you—by searching for keywords that relate to your service. Potential clients typically search for keywords that include clinical issues and their location, such as "depression Chicago" or "eating disorders New York." Even better, unlike much more expensive advertising formats like display ads that you pay for, regardless of whether they generate any calls, with this type of advertising, you pay only when someone clicks on your ad. Their click takes them to a specific page on your website.

Sam seemed interested, but when I told him it costs money for every click, his interest dwindled. I persisted, telling him that he, as the advertiser, would decide how much he was willing to pay for each keyword click, so he could start low and test it out. (Google sets a minimum bid for each keyword.) He still wasn't sure, and asked if I was getting a commission from Google. At this I laughed out loud—if only I were!—and he realized the absurdity of his question. Sam created an ad and because there was no competition among psychologists in Columbus, he immediately showed up at the top of page 1 of Google search results on the far right column of the page under what are called Sponsored Links. Again though, his initial results, in terms of actual referrals, were disappointing.